History and Evidence Regarding Hydrostatic Shock

Abstract

This paper reviews the history and evidence related to remote wounding effects of ballistic pressure waves imparted to tissue by the impact of a bullet. Such remote effects are often referred to as hydraulic or hydrostatic shock. In spite of considerable published evidence and a long history, some medical professionals continue to regard the ability of a bullet to injure tissue that is not directly crushed or stretched as mythical (Jandial R, Reichwage B, Levy M, Duenas V, Sturdivan L. Ballistics for the neurosurgeon. Neurosurgery. 2008:62:472-480.) Early references to these effects date to the 19 th century; however, compelling experimental support and medical findings in human case studies did not become available until the late 20 th and early 21 st century.

Determining the wounding effects of ballistic projectiles to inform future injury models: a systematic review

“…Strong opinion was found dividing between papers suggesting the pressure wave contributes to wound injury5 10 48 – 52 and those that it does not 9 19 37 44. Our review demonstrated that this opinion was based upon five papers describing original experimental data 5 10 51 53 54.…”

“…Overall, 48 of the 59 original papers identified used experimental data derived from bullets; in contrast, there was a relative paucity of experimental data derived from explosive fragments (16/59 of papers). Although strongly expressed opinion was found as to the potential wounding effects of the pressure wave,5 10 48 – 52 our review of the literature could not find objective evidence that this mechanism causes significant injury that either warrants, or enables, modelling at this stage.…”

“…They also felt this mechanism was responsible for causing decreased oxygen consumption in cultured nerve cells in vitro 5. This has been cited as evidence that pressure waves are responsible for neurological symptoms,48 52 despite the lack of clinical data supporting the histological findings. It has been suggested that proponents of the damaging effects of pressure wave52 have also incorrectly reported the results of previous experimental data54 as well as ascribing pressure waves as the cause for a pathology that would be more correctly explained by the effects of the temporary cavity 55.…”

“…This has been cited as evidence that pressure waves are responsible for neurological symptoms,48 52 despite the lack of clinical data supporting the histological findings. It has been suggested that proponents of the damaging effects of pressure wave52 have also incorrectly reported the results of previous experimental data54 as well as ascribing pressure waves as the cause for a pathology that would be more correctly explained by the effects of the temporary cavity 55. Overall, insufficient evidence was found to demonstrate that microscopic changes induced by pressure wave in vitro cause significant clinical damage.…”

Ballistic Trauma-Considerations for the OrthoPlastic Surgical Team

“…The final form of ballistic wound is the generation of a hydrostatic shockwave, which is a controversial topic and of little relevance to the orthoplastic reconstructive surgical team [3,4]. However, this phenomena can rarely cause neuropraxia in nerves distant to the permanent and temporary cavities [5].…”